Facility 222.doc 2026

1. Click ‘Get Form’ to open Facility 222.doc in our editor.
2. Begin by entering the Policyholder Name and Subcontractor Name in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Select your business structure from the options provided: Sole Proprietor, Partnership, Corporation, or Limited Liability Company. If you have a DBA filed, remember to attach a copy.
4. Describe the type of work you perform in the specified section. This helps clarify your role and responsibilities.
5. Indicate whether you hire employees or casual laborers for the policyholder. If yes, provide the number hired and attach a Certificate of Workers’ Compensation Insurance.
6. If you hire subcontractors, answer accordingly and be prepared to provide additional information if required.
7. Confirm your General Liability coverage status by selecting Yes or No. If Yes, ensure to attach a Certificate of General Liability Insurance.
8. List any general contractors or clients you've worked with over the past twelve months to validate your independent contractor status.
9. Finally, sign the form, enter your phone number, date, and email address before submitting it through our platform.

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